Health Bulletin from Botswana

HEALTH BULLETIN FROM BOTSWANA

            I understand that the news Americans get from Africa lately hasn’t been good. The Ebola outbreak in West Africa has people frightened. The end stage of the disease is gruesome and often fatal. Its rapid geometric spread puts thousands of people at risk. The attending health care workers who wear head-to-toe protective gear present a television visual like something out of Robin Cook’s The Hot Zone.

            Let’s get things straight. Africa is a big continent. We are 3000 miles away from the countries of West Africa. Still, for Peace Corps Volunteers in Africa, the news about Ebola has hit closer to home. Volunteers were evacuated from the three affected countries: Liberia, Guinea and Sierra Leone. Two of them were placed in isolation for a time because of some sort of contact with Ebola victims. The infection risk comes from direct contact, and Peace Corps Volunteers are not in the business of providing medical services as such (although there is a new program called Peace Corps Response that supplies American medical workers to a few countries).

            So why the evacuation? From the information we received, it is because of the Ebola-caused degradation of the health care systems in those three countries, systems that Volunteers may need to access for their own medical needs. That is, it wasn’t the fear of Volunteers getting Ebola that caused the evacuation. I also think that Peace Corps has become hypersensitive to bad publicity. The agency was stung recently by a New York Times piece about a young Volunteer in China who died from an intestinal infection. The article included extensive critical statements from the understandably upset parents. But here’s the thing: Volunteers sign up to live as part of communities in mostly rural villages far away from top flight medical centers. While most Volunteers agree that Peace Corps provides them with excellent medical care when needed, it is not the same as health care in the United States. To the extent Peace Corps feels obligated to supply Volunteers with instant access to all types of top-flight medical care, the unintended consequence will be that Volunteers will be less integrated into rural communities. So here’s hoping that doesn’t happen.

            Besides, Ebola is far from being the biggest health threat in Africa. While various malaria interventions have lead to plummeting mortality rates in recent years, the disease still kills more than 500,000 people annually on the continent. HIV rates are very high in some countries, including Botswana, where the incidence among adults is around 25%. In fact Peace Corps Volunteers work in Botswana to change the behaviors that exacerbate the HIV epidemic.

            That’s not to say that health authorities in Botswana aren’t paying attention to Ebola. It’s on the news regularly. There are posters on public buildings alerting people to the threat that is still many miles away. Health workers are receiving special training. We are friendly with public health nurses in Goodhope. Lately they have been putting in time at the nearest border post with South Africa (about 40km from here). They tell us that the immigration folks flag anyone whose passport shows travel in one of the affected countries. The nurse then interviews the person to determine whether he or she poses any health threat.

 

This information poster appears in public places all over the country.

            Enough with the public health discussion. How are the two of us doing? Overall, our health has been excellent. Lots of walking, little access to fast food and a warm, sunny climate do a body good. Still, each of us caught a cold during the winter months (June & July). Once infected, it takes a while to shake it off. The dry climate makes for more coughing and bronchitis, which takes a while to go away. We are fully recovered now.

 

Despite suffering from bronchitis, Stephanie bravely waited at a bus shelter for a combi to take us on our weekly shopping trip. Note the hospital gurney parked nearby, ready to whisk her away in case she were to collapse. On closer inspection, the gurney was missing a wheel, and a rock propped up one corner.

            Before we return home in November, Peace Corps will put us through a battery of tests for various diseases, including HIV and tuberculosis (which is also a problem here). We will have to produce stool samples on three consecutive days for assorted parasite testing. Stephanie says that the surest way for her to be unable to produce a stool sample is to be told that she needs to produce one. Then we will receive a pill to eliminate the freshwater-endemic schistosomiasis (bilharzia) parasite, which we are to take as a precaution, even if we test negative.

            One last comment about Ebola. Part of the challenge facing health workers in West Africa has been misinformation about the cause and treatment of the disease. Some of that misinformation is spread by people who should know better. Nearby Nigeria is famous for its television preachers. They boldly claim that they can heal many types of afflictions. On one popular television network, available throughout Africa, a preacher regularly presents testimonials from people who claim to have been cured of AIDS through prayer and the laying of hands. Such misinformation can limit the effectiveness of our HIV prevention work here. With respect to Ebola, the Nigerian government has called on these preachers to cool it. For once, they may be listening. Let’s hope so.

Satellite TV broadcast from Nigeria showing a woman testifying about her medical condition. The caption reads: "Healed of HIV/AIDS Positive".

The Boys of Winter

THE BOYS OF WINTER

            I wrote more than a year ago about Peace Corps’ long association with softball in Botswana. I also described my own effort to continue that heritage by helping to coach boys and girls softball at my school. Here is an update.

            As you may recall, softball takes place during “ball sports” season, roughly from April into July. June and July are winter, the coldest time of the year here. Practices take place late in the afternoon at the end of a long day: classes run from 7:40 to 1:30, then lunch break lasts from 1:30 to 2:30 followed by study time from 2:30 to 4:00. The students quickly change from their school uniforms into sports attire and hit the adjacent ball fields. They finish practice around 5:30. Then they head home. Some walk 10 km or more, and so arrive after dark.

Our girls warming up at an after school practice. Note the girl in pink with the pink trimmed glove sent from Manchester.

            Organizing games requires much more effort than in the United States. Because buses are difficult to commandeer, minimizing transport to games is a priority. Teams from several schools assemble at one school late on a Friday. Everyone stays over for the whole weekend, playing three or more games in round robin fashion. After a couple of these weekend tournaments, the best boys and girls teams from a cluster of schools meet in a weekend sub-zonal elimination tournament. The best teams from that tournament go on to one of four zonal tournaments. The top two teams from each of the four zones then advance to the national tournament, from which Botswana’s top boys and girls softball teams are crowned. The same gauntlet applies to the other ball sports: football (soccer), volleyball, netball, basketball (in some schools), table tennis and badminton.

            Our softballers love going to tournaments. They spend the weekend with their friends from all of the other ball sports. They don’t have to perform their typical weekend chores: washing laundry, preparing meals, cleaning house and tending livestock. Instead, they sleep together in classrooms (boys in one, girls in another) at the host school. The classrooms are not heated, and it can get below freezing at night. So several students might share a foam mattress and sleep under shared warm blankets. There is even more to like: they don’t have to wear their school uniform and they bring along music to play.

 

Our boys pick up their classroom bedding before dawn at the beginning of a tournament day.

            Where do I fit into all of this? I come to the tournaments. Sometimes I (along with other coaches) sleep in the classroom with the boys. I assemble a bed from six desks, and then put a yoga pad and sleeping bag on top. It isn’t the best night’s sleep, since the boys can’t help but chatter long after bedtime. Other nights we coaches find a spare empty classroom and camp out there, in relative quiet.

            Food is also a big attraction at tournaments. Our school cooks come along for the weekend. They bring food, kettles, a propane tank and portable gas kitchen burners. They set up their kitchen in a classroom, the same classroom where our girls sleep. All weekend long, the cooks are busy preparing and cooking fresh acorn squash, paleche (white maize meal), stewed beef and gravy. The athletes love the rich food: there are never leftovers.

            In 2013, our school’s girls team made it to the zonals for the first time ever. This year, the girls did not make it to zonals, but the boys did, after a tournament drought of many years. Once there, things did not go so well. We had a strong pitching staff (two players), and they could get the ball into the strike zone most of the time (and this is fast pitch). Our first baseman snagged almost every ball coming his way and made more than his share of outs. The rest of our squad consisted of good hitters, but less than ideal fielders. Remember that these boys never played Little League. They likely never experienced softball before they got to 8^th grade.

 

Our short stop and third base players moving infield to get ready for the next play at a tournament.

            The bottom line: our boys team did not advance beyond the zonals. As they say, there’s always next year. We have some good returning players, and there are good coaches. Unfortunately I won’t be around then. When this is all over, as odd as it sounds, coaching softball at my school may be one of the things I will miss most about my Peace Corps experience.

 

The Boys of Winter (with me). South Zonal Tournament, Lobatse.

            A special thanks to friends from Manchester who responded to my call to send softball gloves. Because of them, we had enough gloves for the boys and girls starting lineups this year.